U.S. patent number 7,291,118 [Application Number 10/234,964] was granted by the patent office on 2007-11-06 for method for determining the risk of developing a skeletal condition.
This patent grant is currently assigned to Biotonix Inc.. Invention is credited to Sylvain Guimond, Tracey A. McCulloch, David H. McFarland, Timothy K. Woo.
United States Patent |
7,291,118 |
McFarland , et al. |
November 6, 2007 |
Method for determining the risk of developing a skeletal
condition
Abstract
The present invention relates to a method and apparatus for
calculating postural deviation values indicative of a skeletal
condition risk in a patient including the steps of obtaining
position data identifying a position in space of body landmarks of
an upper body of a patient while standing relaxed and in normal
posture; obtaining weight data of the patient; calculating vertical
and horizontal plumb line using the position data; and calculating
angle deviation values of body parts of the patient being
indicative of a skeletal condition risk with respect to the plumb
line position value using the position data.
Inventors: |
McFarland; David H. (Town of
Mount Royal, CA), McCulloch; Tracey A. (Montreal,
CA), Woo; Timothy K. (Montreal, CA),
Guimond; Sylvain (Ste-Anne de Sorel, CA) |
Assignee: |
Biotonix Inc. (Montreal,
Quebec, unknown)
|
Family
ID: |
31977491 |
Appl.
No.: |
10/234,964 |
Filed: |
September 5, 2002 |
Prior Publication Data
|
|
|
|
Document
Identifier |
Publication Date |
|
US 20040049103 A1 |
Mar 11, 2004 |
|
Current U.S.
Class: |
600/587;
600/594 |
Current CPC
Class: |
A61B
5/103 (20130101); A61B 5/4561 (20130101) |
Current International
Class: |
A61B
5/103 (20060101) |
Field of
Search: |
;600/587,594,595
;482/8,9 ;128/920,923 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
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|
Primary Examiner: Marmor; Charles
Attorney, Agent or Firm: Fay Kaplun & Marcin, LLP
Claims
What is claimed is:
1. A method for determining a risk value of developing a skeletal
condition in a patient, the method comprising steps of: a) taking
at least one picture of said patient and obtaining position data
from said picture identifying a position in space of body landmarks
of the upper body of a patient while standing relaxed and in normal
posture; b) establishing a relationship between risk of developing
a skeletal condition and a plurality of factors including posture;
c) calculating at least two of head angle, thoracic curve, lumbar
curve and pelvis tilt angle deviation values of said patient using
the position data; and d) calculating said risk of developing a
skeletal condition using said angle deviation values and said
relationship.
2. The method of claim 1, wherein said skeletal condition is
fracture.
3. The method of claim 2, wherein said fracture is selected from
the group consisting of neck fracture and hip fracture.
4. The method of claim 2, wherein said relationship is ((Age
factor.times.0.15)+(Postural factor.times.0.50)+(Height Change
factor.times.0.15)).times.BMI factor.
5. The method of claim 4, wherein said postural factor is
calculated in a manner in which head angle contributes for about
25% of the postural factor, kyphosis contributes for about 50% of
the postural factor, lordosis contributes for about 13% of the
postural factor and pelvic angle contributes for about 12% of the
postural factor.
6. The method of claim 1, wherein said body landmarks are tragus,
acromion, C7 vertebrae, T5 vertebrae, anterior-superior iliac spine
and posterior-superior iliac spine.
7. The method of claim 6, wherein a flat marker is placed on the
tragus and spherical markers are placed on the acromion, C7
vertebrae, T5 vertebrae, anterior-superior iliac spine and
posterior-superior iliac spine.
8. The method of claim 1, wherein said at least one picture is a
lateral view of said patient.
9. The method of claim 1, wherein said angle deviations calculated
are head angle, thoracic curve or kyphosis, lumbar curve or
lordosis, and pelvis tilt.
10. The method of claim 9, wherein said angle deviation values are
referenced with respect to average values.
11. The method of claim 9, wherein said skeletal condition is
osteoporosis.
12. The method of claim 9, wherein step (de) includes calculating a
postural factor in which head angle contributes for about 25% of
the postural factor, kyphosis contributes for about 50% of the
postural factor, lordosis contributes for about 13% of the postural
factor and pelvic angle contributes for about 12% of the postural
factor.
13. The method of claim 12, further comprising calculating a body
mass index (BMI) for the patient, and determining lordosis angle to
be pelvic angle plus about 22 degrees when BMI is greater than
about 25kg per m.sup.2.
14. The method of claim 1, wherein said skeletal condition is
osteoporosis.
15. The method of claim 14, wherein said relationship is ((Age
factor.times.0.35)+(Postural factor.times.0.30)+(Height Change
factor.times.0.15)).times.BMl factor.
16. The method of claim 15, wherein said postural factor Is
calculated in a manner in which head angle contributes for about
25% of the postural factor, kyphosis contributes for about 50% of
the postural factor, lordosis contributes for about 13% of the
postural factor and pelvic angle contributes for about 12% of the
postural factor.
17. A method of selecting exercises for reducing risk to develop a
skeletal condition in a patient, the method comprising the steps
of: a) obtaining angle deviations of body part of a patient
indicative of a risk to develop a skeletal condition, said angle
deviations comprising at least two from the group consisting of
head angle, thoracic curve, lumbar curve and pelvis tilt; b)
correlating angle deviations with exercises for strengthening or
stretching specific muscles or muscle groups; c) compiling an
exercise program based on the exercises provided in step b).
18. The method of claim 17, wherein the step of compiling comprises
manually selecting exercises from a list of exercises.
19. The method of claim 17, wherein said skeletal condition is
selected from the group consisting of osteoporosis and
fracture.
20. The method of claim 19, wherein said fracture is selected from
the group consisting of neck fracture and hip fracture.
21. The method of claim 17, wherein said angle deviations comprise
head angle, thoracic curve, lumbar curve and pelvis tilt.
22. An apparatus for estimating skeletal condition risk in a
patient comprising: a) a position data acquisition device for
identifying a position in space of body landmarks of an upper body
of the patient while standing relaxed and in normal posture; b) an
angle of deviation calculator for determining angle deviation
values of body parts being indicative of a skeletal condition risk
using the position data, said angle deviations comprising at least
two from the group consisting of head angle, thoracic curve, lumbar
curve and pelvis tilt; and c) a calculator adapted to calculate a
value for said risk using a relationship between said risk and a
plurality of factors including said angle deviation values.
23. The apparatus of claim 22, wherein said skeletal condition is
selected from the group consisting of osteoporosis arid
fracture.
24. The apparatus of claim 23, wherein said fracture is selected
from the group consisting of neck fracture and hip fracture.
25. The apparatus of claim 22, wherein said angle deviation value
is with respect to average or normal value.
26. An apparatus for selecting exercises for reducing risk to
develop a skeletal condition in a patient comprising: a) an angle
of deviation device for obtaining angle deviations of an upper body
part of a patient being indicative of a risk to develop a skeletal
condition, said angle deviations comprising at least two from the
group consisting of head angle, thoracic curve, lumbar curve and
pelvis tilt; b) a correlator for correlating angle deviations with
exercises for strengthening or stretching muscles or muscle groups;
c) a compiler for compiling an exercise program based on the
exercises provided in step b).
Description
BACKGROUND OF THE INVENTION
(a) Field of the Invention
This invention relates a method and apparatus for determining a
risk factor indicative of a predisposition to develop a skeletal
condition as osteoporosis or a fracture.
(b) Description of Prior Art
Osteoporosis is known as the silent disease. It is characterized by
progressive bone thinning leading to fragility and fracture. It is
often only diagnosed once a fracture has been experienced. More
than 25 million Americans are affected, 80% of whom are women. It
has been estimated that one out of every two women and one out of
every five men will experience an Osteoporosis-related fracture
sometime in their life. By age 75, one third of all men will be
affected by Osteoporosis. Estimated direct expenditures (hospitals
and nursing homes) in the U.S. for osteoporosis and related
fractures are $14 billion each year.
SUMMARY OF THE INVENTION
It is an object of the invention to provide a method and apparatus
for determining a risk factor indicative of a predisposition to
develop a skeletal condition as osteoporosis or a fracture.
The present invention is related to a biomechanical assessment
system that analyzes posture. It helps to identify the postural
indicators that are associated with a predisposition to a skeletal
condition as osteoporosis to provide early detection and minimize
the consequences of this disease.
The skeleton is comprised of a network of bones connected by
tendons and ligaments, surrounded by muscle. The strength and
integrity of this skeletal system enables us to function well.
Bones store calcium, help protect the body from injury, produce
blood cells and house the brain and the central nervous system. The
skeletal system serves as the framework to support the body, with
the bones of the legs and the back supporting body weight.
Posture is a significant indicator of the health of our skeletal
frame. An optimum posture would have a plumb line (like the lines
used in building) dropping from the level of your ear straight to
your shoulder, lining up through the middle of your pelvis, knees
and feet. The head, trunk, pelvis and knees are "stacked", one on
top of the other. Any deviation from this position can negatively
affect health and well-being. Certain postural asymmetries may
particularly indicate a risk for Osteoporosis and may contribute to
an increased risk of associated fracture.
One object of the present invention is to detect and highlight the
postural indicators that identify predisposition to osteoporosis to
provide an early detection and to minimize the consequences of this
disease.
Another object of the present invention is to detect and highlight
the postural indicators that identify a predisposition to risk of
fracture due to osteoporosis and minimize risk of fracture through
corrective exercise regimes.
The invention improves the accuracy, objectivity and/or simplicity
of obtaining data that can be used in diagnosis of osteoporosis.
The invention provides better selection of exercises useful in the
treatment of osteoporosis. The invention also improves confidence,
with the patient and/or the physician, that exercises used to treat
osteoporosis are having a continued positive effect.
In accordance with the present invention, there is provided a
method and apparatus for determining a risk factor indicative of a
predisposition to develop a skeletal condition as osteoporosis or a
fracture.
According to one broad aspect of the present invention, there is
provided a method for calculating postural deviation values
indicative of a skeletal condition risk in a patient comprising the
steps of: a) obtaining position data identifying a position in the
space of body landmarks of upper body of a patient while standing
relaxed and in normal posture; b) obtaining weight data of the
patient; c) calculating vertical and horizontal plumb line using
the position data; d) calculating angle deviations values of body
parts of the patient being indicative of a skeletal condition risk
with respect to the plumb line position value using the position
data.
According to another broad aspect of the present invention, there
is provided a method of selecting exercises for reducing risk to
develop a skeletal condition in a patient, the method comprising
the steps of: a) obtaining angle deviations of body part of a
patient indicative of a risk to develop a skeletal condition; b)
correlating angle deviations with exercises for strengthening or
stretching specific muscles or muscle groups; c) compiling an
exercise program based on the exercises provided in step b).
According to still another broad aspect of the present invention,
there is provided an apparatus for calculating postural deviation
values indicative of a skeletal condition risk in a patient
comprising: a) position data acquisition device for identifying a
position in space of body landmarks of upper body of the patient
while standing relaxed and in normal posture; b) weight data
acquisition device for obtaining weight data of the patient; c)
vertical and horizontal plumb line determination device using the
position data; d) angle of deviation calculator for determining
angle deviation values of body parts being indicative of a skeletal
condition risk with respect to the plumb line position value using
the position data.
According to a further broad aspect of the present invention, there
is provided an apparatus for selecting exercises for reducing risk
to develop a skeletal condition in a patient comprising: a) a angle
of deviation device for obtaining angle deviations of upper body
part of a patient being indicative of a risk to develop a skeletal
condition; b) a correlator for correlating angle deviations with
exercises for strengthening or stretching muscles or muscle groups;
c) a compiler for compiling an exercise program based on the
exercises provided by the correlator.
BRIEF DESCRIPTION OF THE DRAWINGS
These and other features, aspects and advantages of the present
invention will become better understood with regard to the
following description and accompanying drawings wherein:
FIG. 1 illustrates the contour silhouette of the back of a patient
and the lines extrapolated from the upper thoracic vertebrae (T1)
and the lower thoracic vertebrae (T2);
FIG. 2 illustrates the calculation of the head angle, lordosis
angle, kyphosis angle and pelvic angle;
FIG. 3 illustrates an example of the assessment report of one
embodiment of the present invention;
FIG. 4 is a block diagram of the method for assessing a risk of
developing a skeletal condition of a preferred embodiment of the
present invention; and
FIG. 5 is a schema of the system of a preferred embodiment of the
present invention.
DETAILED DESCRIPTION OF THE INVENTION
In accordance with the present invention, there is provided a
method and apparatus for determining a risk factor indicative of a
predisposition to develop a skeletal condition as osteoporosis or a
fracture.
The present invention is designed to identify the potential for
Osteoporosis and to serve as an early warning or screening tool.
Posture is examined by means of a lateral view photo. Spinal
contour is extracted from the digital image, sent via the web to a
central server and software is used to detect postural deviations
of various body segments and compare them to established norms. An
Osteoporosis Postural Index (OPIX) is formed summarizing the
postural orientations of different body segments. This provides the
input stage to an expert system designed to weight the body segment
and deviation magnitudes from normal and to form two related
indices: risk of osteoporosis and risk of bone fracture related to
osteoporosis.
The Osteoporosis Index is designed to identify if a patient's
posture is associated with Osteoporosis, and the Risk Fracture
Index indicates the potential for fractures. This screening tool
leads to early detection and treatment to minimize the consequences
of osteoporosis. Beyond the screening function of the risk
assessment report, corrective exercises are available to the
healthcare practitioner that target the specific postural
deviations individually identified in the osteoporitic patient,
with the goal of minimizing risk of fracture and improving daily
living.
An expert database is formed of various postural parameters
associated with osteoporosis further refining the detection
capabilities of the system and improving its role as an early
warning/screening device.
Six, light-reflective markers (1 flat and 5 spherical) will be
placed on well-defined anatomical landmarks. More specifically,
markers will be placed over the tragus (flat marker), acromion. C7,
T5, Anterior-superior iliac spine (ASIS), and Posterior-superior
iliac spine (PSIS). The positioning of the markers and the
obtention of their space position is more detailed in U.S. Pat. No.
6,514,219 which is incorporated by reference and in the
International Patent Application No. PCT/CA01/01649.
Digital photograph is taken of the client against a calibrated
backdrop.
Photo is loaded into the computer, indwelling software is used to
scan the image, extract the spinal contour and marker locations,
and transmit the data via the Internet to a central server for
processing.
Head angle, pelvic tilt and kyphosis and lordosis (the latter
highly indicative of osteoporosis) are calculated.
The marker orientation (in angles) relative to vertical (head) and
horizontal (pelvic) plumb lines are calculated.
A contour silhouette of the back in the lateral view is used to
calculate Kyphosis and lordosis Two lines are extrapolated from the
contour mapping the upper thoracic vertebrae (T1, T2) and the lower
thoracic vertebrae (T11, T12) (FIG. 1). An angle (ky.degree.) is
measured from these two lines to give an index of kyphosis. Norms
exist for comparisons to measured variables. Lordosis is measured
(Ld.degree.) similarly using the lower thoracic vertebrae (T1, T12)
and the lower lumbar vertebrae (L4, L5). T12 is estimated using the
location of T5. The distance from T1 to T5 is approximately 30% of
the distance from T1 to T12 (FIG. 2).
In the event the subject has excess fatty tissue around the
abdominal area that may obscure the contour silhouette, and
alternative method is used to estimate lordosis. The Body Mass
Index (BMI) is used to estimate obesity and the probability that
the contour is obscured due to body fat. If BMI is greater than 25
kg/m.sup.2, pelvic angle is used to estimate lordosis. A normal
pelvic angle of 10.degree. has been shown to be approximately equal
to the normal lordotic angle of 32.degree., and increases in pelvic
angle from normal are related to increases in lordosis. If
BMI>25 then Ld.degree.=Pa.degree.+22.degree. Body Mass Index
(BMI) is calculated by taking the subject's weight in kilograms and
dividing it by the height in meters squared. The formula is
.times..times..times..times. ##EQU00001##
Head angle (Ha.degree.) is measured from the flat marker placed on
the tragus to spherical marker placed on C7 relative to vertical
plumb.
Pelvic angle (Pa.degree.) is measured from the spherical markers
placed on PSIS and ASIS and relative to horizontal plumb.
The head angle, kyphosis measure and lordosis/pelvis angle measures
will be applied to an expert database and two indices will be
formed that indicates the risk of osteoporosis and the risk of
fracture associated with osteoporosis.
Osteoporosis Postural Index (OPIX)
As mentioned above, a series of postural measures is made from the
lateral digital photograph and contour definition (utilizing
anatomical markers). The information obtained is used to calculate
an Osteoporosis Postural Index (OPIX). The components of the OPIX
will be: Head angle: The value given is Ha.degree.-40.degree..
Positive values indicate head is forward and negative values
indicate head is posterior. Normal angle is 40.degree..
Kyphosis: The value given is Kr.degree.-37.degree., Positive values
indicate increases in Kyphosis, and negative values hypokyphosis.
Normal kyphotic curve is 37.degree..
Lordosis: The value given is Ld.degree.-32.degree.. Positive values
indicate hyper-lordosis (increase in lordosis) and negative values
indicate hypo-lordosis (decrease in lordosis). Normal lordotic
angle is 32.degree.. Pelvic angle: The value given is
Pa.degree.-10.degree.. Positive values indicate anterior pelvic
tilt and negative values indicate posterior pelvic tilt. Normal
pelvic angle is 10.degree.. Risk Indices
The values used to identify body alignment and posture are combined
with other measured variables to form two risk indices: the
Osteoporosis Risk Index and the Osteoporosis Fracture Index.
Different "weightings" of these variables are used to provide
personalized risk assessments for these two fundamental components
of osteoporosis. The variables are: Posture, age, height change,
sex and BMI.
Osteoporosis Risk Index
In a preferred embodiment of the present invention, the relative
"weights" or percentages of these factors for the Osteoporosis Risk
Index are Age (35%), Posture (30%), BMI (20%) and Height Change
(15%).
The Osteoporosis risk factor is obtained by the formula:
Osteoporosis risk factor=((Age factor.times.0.35)+(Posture
factor.times.0.30)+(Height Change factor.times.0.15)).times.BMI
factor
The osteoporosis risk factor is a number between 0 and 100 with
higher numbers indicating greater risk of osteoporosis. This is in
turn converted to a color scale from green (low risk values) to red
(high risk values) on an assessment report as illustrated in FIG.
3.
Age Factor
After 35, bone mineral density decreases by 0.4% per year until age
45, past 45, the rate of bone density decrease is 2% per year.
Normal Bone mass in females is 1.2 g/cm.sup.2, mild bone loss is
1.05 to 1.19, moderate is 0.91 to 1.04 and severe is 0.75 to 0.90
g/cm.sup.2. From normal to severe, there is a 0.3 g/cm.sup.2 or a
decrease in 25% bone density. Normal bone mass is estimated in
males to be 2.1 g/cm.sup.2. From normal to severe, there is a 1.2
g/cm.sup.2 or a decrease in 57% in bone mass density in males.
Table 1 is listing the age factor coefficients and their
conditions:
TABLE-US-00001 TABLE 1 Age factor coefficients Age Factor
Conditions 0 Female and age .ltoreq.35 .times..times..times..times.
##EQU00002## Female and age >35 and .ltoreq.45
.times..times..times..times. ##EQU00003## Female and age >45 and
.ltoreq.55 100 Female and age is >55 0 Male and age .ltoreq.35
.times..times..times..times. ##EQU00004## Male and age >35 and
.ltoreq.45 .times..times..times..times. ##EQU00005## Male and age
>45 and .ltoreq.72 100 Male and age is >72
Posture Factor
A postural component score is formed with different weights
provided for the different measures described above. Head angle
contributes for 25% of the postural factor, Kyphosis contributes
for 50% of the postural factor, Lordosis contributes for 13% of the
postural factor and Pelvic angle contributes for 12% of the
postural factor.
Normal Ha.degree. is 35.degree. and maximum Ha.degree. is
45.degree.. The greater the head angle, the greater the risk of low
bone density (see formulas P1 below).
Normal Ky.degree. is 37 and maximum Ky.degree. is 80.degree..
Greater Ky.degree. indicates a greater risk of low bone density
(see formulas P2 below).
Normal Ld.degree. is 32.degree., maximum Ld.degree. is 56.degree.
and minimum is 3.degree.. The further Ld.degree. deviates from
32.degree. (either in the positive or negative direction) the
greater the risk of low bone density (see formulas P3 below).
Normal Pa.degree. is 10.degree., maximum Pa.degree. is 32.degree.
and minimum is -9.degree.. The further Pa.degree. deviates from
10.degree. (in the positive or negative directions) the greater the
risk of low bone density (see formulas P4 below).
Table 2 lists the formulas for calculating the Head angle element
of the postural factor.
TABLE-US-00002 TABLE 2 Head angle element of postural factor Head
Angle P1 Formula Ha.degree. .ltoreq.35 0 Ha.degree. >35.degree.
and .ltoreq.45.degree. .degree..times. ##EQU00006## Ha.degree.
>45.degree. 100
Table 3 lists the formulas for calculating the Kyphosis element of
the postural factor.
TABLE-US-00003 TABLE 3 Kyphosis element of postural factor Kyphosis
P2 Formula Ky.degree. .ltoreq.37.degree. 0 Ky.degree.
>37.degree. and .ltoreq.80.degree. .degree..times. ##EQU00007##
Ky.degree. >80.degree. 100
Table 4 lists the formulas for calculating the Lordosis element of
the postural factor.
TABLE-US-00004 TABLE 4 Lordosis element of postural factor Lordosis
P3 Formula Ld.degree. <3 100 Ld.degree. .gtoreq.3.degree. and
<32.degree. .degree..times. ##EQU00008## Ld.degree. = 32.degree.
0 Ld.degree. >32 and .ltoreq.56.degree. .degree..times.
##EQU00009## Ld.degree. >56.degree. 100
Table 5 lists the formulas for calculating the Pelvic angle element
of the postural factor.
TABLE-US-00005 TABLE 5 Pelvic angle element of postural factor
Pelvic angle P4 Formula Pa.degree. <-9.degree. 100 Pa.degree.
.gtoreq.-9.degree. and <10.degree. .degree..times. ##EQU00010##
Pa.degree. = 10.degree. 0 Pa.degree. >10 and .ltoreq.32.degree.
.degree..times. ##EQU00011## Pa.degree. >32.degree. 100
The Posture factor is finally calculated from the formula: Posture
factor=(P1.times.0.25)+(P2.times.0.5)+(P3.times.0.13)+(P4.times.0.12)
Height Change Factor
Height loss is indicative of osteoporosis and kyphosis is related
to height loss. To estimate the potential height change associated
with osteoporosis, the following method is used. If the kyphotic
angle (Ky.degree.) is greater than 37.degree., measured height
increase 0.267 cm for every 1.degree. increase in kyphosis past
37.degree.. If the kyphosis angle is less than 37.degree., no
adjustment is made to measured height. Kyphosis has a maximum
impact on height loss of 11 cm, consequently, measured height is
adjusted to a maximum of 11 cm. The maximum amount of kyphosis is
80.degree., and normal is 37.degree., giving a difference of
43.degree., converted to height loss in cm of 11.
Table 6 lists the formulas for calculating the baseline height
element of the height change factor.
TABLE-US-00006 TABLE 6 Baseline height element of the height change
factor Ky Baseline height Ky.degree. .ltoreq.37.degree. measured
height Ky.degree. >37.degree. .degree..times..times..times.
##EQU00012##
The Height change factor is calculated from the following
formula:
.times..times..times..times..times..times..times..times..times.
##EQU00013## BMI Factor
The BMI factor is applied to the previously calculated variables.
Low BMI is related to low bone mass and higher risk of
osteoporosis. If females have a BMI below 25 kg/m.sup.2, risk
increases by 25.3%. If males have a BMI below 27 kg/m.sup.2, risk
increases by 25.3%.
Table 7 lists the BMI factors depending on the patient's BMI.
TABLE-US-00007 TABLE 7 BMI factors BMI BMI factors BMI .ltoreq. 25
kg/m.sup.2 for females 1.25 BMI > 25 kg/m.sup.2 for females 1
BMI .ltoreq. 27 kg/m.sup.2 for males 1.25 BMI > 27 kg/m.sup.2
for males 1
Fracture Risk Index
The Fracture risk index is calculated similarly to the Osteoporosis
Risk Index but with different "weights" for the factors. Postural
variables are highly predictive of fracture related to
osteoporosis. Age will represent 15%, posture represents 50%, BMI
represents 20% and Height change represents 15% of the fracture
risk index. The formula for calculating of the Fracture risk index
is the following: Fracture risk index=((Age
factor.times.0.15)+(Posture factor.times.0.50)+(Height Change
factor.times.0.15)).times.BMI factor
The fracture risk index is a number between 0 and 100 with higher
numbers indicating greater risk of fracture, as for example a neck
fracture or a hip fracture. This is converted to a color scale from
green (low risk values) to red (high risk values) on an assessment
report as illustrated in FIG. 3.
Assessment Report
In a preferred embodiment of the present invention, an assessment
report as illustrated in FIG. 3 is provided to the patient. This
report contains the following components:
Lateral view photographs of the patient with head angle and pelvic
angles and spinal curvature (showing kyphosis and/or lordosis)
highlighted and compared to normal spinal curvature.
The Osteoporosis Postural Index. The key postural indicators of
Osteoporosis are shown and compared to normal values.
The Osteoporosis Risk Index and the Fracture Risk Index are
presented with color scaling to indicate risk status. Measures in
the "green" area are considered as acceptable, measures in the
"yellow" area are indicating a moderate risk (with a follow up
OsteoPrint to be scheduled annually), and measures in the "red"
area are indicating an immediate risk. For measures in the "yellow"
or "red" areas, corrective or preventative exercises can be
provided.
A tracking feature shows the progression of the subject's posture
based on the spine extrapolated from the photo taken at the annual
evaluations.
Exercise Progression Logic
The programs are prescribed with the approval of the patient's
primary physician and/or physical therapist and the programs are
preferably performed with all sessions beginning with a warm-up.
The warm-up preferably consists of weight bearing activity (stair
climbing, beginner step class, low impact aerobics, walking) that
elevates the patient's heart rate slightly (refer to heart rate
tables) for preferably 10 minutes. Moderate muscle fatigue should
occur after 10 15 repetitions when performing the strengthening
exercises. If it does not, it is preferable to increase the amount
of applied resistance (no more than %10 increase each week)
Contraindicated movements/exercises for an individual with
osteoporosis include: trunk flexion, trunk rotation, trunk lateral
flexion and the patient should avoid rowing machines.
Strengthening is preferably submaximal, incorporating the major
muscle groups and performed as tolerated by the individual
patient.
Three types of exercise are particularly recommended for
osteoporosis at risk patients: Low bone density exercise (impact
exercise), postural exercises and preventative strengthening
exercises (maintenance program incorporating the major muscle
groups)
The programs can be supervised exercise (SE), non-supervised
exercise (NS), equipment based exercise (EE), or home based
(HE).
In a program, different combinations of types of programs can be
used. Table 8 is providing examples of exercises for different
combinations.
TABLE-US-00008 TABLE 8 Combinations and examples of exercises
Combination Examples of exercises SE/EE/Low bone density exercise
treadmill, stairmaster with a personal trainer or supervised
SE/EE/postural exercise Pulley machines and free weights with a
personal trainer or supervised SE/EE/maintenance exercise Free
weights, equipment, large muscle group exercises with a personal
trainer or supervised SE/HE/Low bone density exercise Group power
walk, step class led by an instructor SE/HE/postural exercise
Supervised posture exercises with or without dumbbells and/or
elastic resistance SE/HE/maintenance exercise Supervised
maintenance exercises with or without dumbbells and/or elastic
resistance NS/EE/Low bone density exercise treadmill, stairmaster,
no supervision NS/EE/postural exercise Pulley machines and free
weights no supervision NS/EE/maintenance exercise Free weights,
equipment, large muscle group exercises with no supervision
NS/HE/Low bone density exercise Speed walking, stairclimbing,
stepping with no supervision NS/HE/postural exercise Postural
exercises with or without dumbbells and/or elastic resistance, no
supervision NS/HE/maintenance exercise Maintenance exercises with
or without dumbbells and/or elastic resistance, no supervision
Patients with a low risk of osteoporosis/fracture are preferably
exercising in a very similar manner than in regular exercise
prescription (however, careful with patient positioning during the
execution of each exercise)
Strength Exercises
10 15 repetitions 2 3 sets Perform 3 4 times per week Flexibility
Hold each stretch for 30 seconds and repeat 3 times
Patients with a moderate risk of osteoporosis/fracture are
preferably exercising with a lower intensity, conservative exercise
prescription than that normally given to a healthy population.
Careful consideration is given to patient positioning during the
execution of each exercise
Strength Exercises
10 15 repetitions 2 sets Perform exercises every third day
Flexibility Hold each stretch for 30 seconds and repeat 3 times
Patients with a high risk of osteoporosis/fracture are preferably
exercising with a very low intensity and more conservative exercise
prescription than normally given to a healthy population. Careful
consideration is given to patient positioning during the execution
of each exercise.
Strength Exercises
10 15 repetitions (as tolerated by the individual patient). 1 2
sets Perform exercises every third day (Katz, 1998.) Flexibility
Hold each stretch for 30 seconds and repeat 3 times
There is provided examples of unsupervised, home-based exercise
progressions for four potential deviations. The deviations are the
following: Forward head position, thoracic kyphosis, lumbar
hyperlordosis and lumbar hypolordosis.
These exercise programs have been designed to be of 10 weeks
duration, which is comprised of three sessions respectively. The
first session are of 4 weeks in duration, the second and third
sessions are both be three weeks long, respectively.
EXAMPLE 1
Mild Osteoporosis Risk
TABLE-US-00009 Target Areas/ Name of exercise to be Deviation
Exercises Session# linked Forward head Chin tuck 1: Standing chin
tuck 2: Lying chin tuck 3: Lying chin tuck Kyphosis rowing
(scapula) 1. Standing, bilateral rowing with elastic resistance 2.
Prone, on a bench, rowing with weight 3. Prone, on a bench, rowing
with weight external shoulder 1. Seated with elastic rotation
resistance 2. Side lying on floor or bench with weight 3. Side
lying on floor or bench with weight trunk extension (lift 1. Back
extension with primarily the upper pillow under hips arms chest off
the by your side floor) 2. Back extension with pillow under hips
arms beside your head 3. Back extension with pillow under hips
hands holding weight cobra (keep Chest lift elbows elbows on the on
the floor (all floor) sessions) pec stretch 1. Unilateral chest
stretch 2. Chest stretch in a doorframe 3. Chest stretch in a
doorframe hyperlordosis abs abdominal hollowing (isometric) all
sessions Hip extensor 1. bridge strengthening 2. Prone on bench or
floor leg straight 3. Prone on bench or floor bent knee with weight
Hip flexor stretch 1. Lunge stretch holding a chair 2. Standing
quad stretch holding a chair 3. Side-lying quad stretch Lower back
stretch Supine, knees to chest (all sessions) hypolordodis back
extension 1. Back extension with pillow under hips, arms by your
side 2. Back extension with pillow under hips, arms beside your
head 3. Back extension with pillow under hips, hands holding weight
strengthen quads 1. Seated knee lifts with and hip flexors weight
(in a chair) 2. Standing leg lift front with weight 3. Standing leg
lift front with elastic cobra Chest lift elbows on the floor (all
sessions) Hamstring stretch Supine, on the floor with a towel
around the foot (all sessions)
EXAMPLE 2
Moderate Osteoporosis Risk
TABLE-US-00010 Target Areas/ Name of exercise to be Deviation
Exercises Session# linked Forward head Chin tuck 1: standing chin
tuck 2: Lying chin tuck 3: Lying chin tuck Kyphosis Rowing
(scapula) 1. Prone on the floor arms bent beside your head 2.
standing bilateral rowing with elastic resistance 3. prone on a
bench rowing with weight external shoulder 1. Seated with elastic
rotation resistance 2. Seated with elastic resistance 3. Side lying
on floor or bench with weight trunk extension (lift 1. Back
extension with primarily the upper arm assistance chest off the
floor 2. Back extension with pillow under hips arms by your side 3.
Back extension with pillow under hips arms beside your head cobra
(keep elbows Chest lift elbows on on the floor) the floor (all
sessions) Pec stretch 1. Supine, arms out to the side palms up 2.
Unilateral chest stretch 3. Bilateral in a doorframe hyperlordosis
Abs abdominal hollowing (isometric) all sessions Hip extensors 1.
Bridge (very low) 2. Bridge 3. Prone on bench or floor leg straight
Hip flexor stretch 1. Lunge stretch holding a chair 2. Lunge
stretch holding a chair 3. Standing quad stretch holding a chair
Lower back stretch Supine, knees to chest (all sessions)
hypolordodis Back extension 1. Back extension with arm assistance
2. Back extension with pillow under hips arms by your side 3. Back
extension with pillow under hips arms beside your head Hip flexor
1. Seated knee lifts with strengthening weight (in a chair) 2.
Standing leg lift front with elastic resistance 3. Standing leg
lift front with weight Cobra (elbows Chest lift elbows on on the
floor) the floor (all sessions) Hamstring stretch Supine, on the
floor with a towel around the foot (all sessions)
EXAMPLE 3
High Osteoporosis Risk
TABLE-US-00011 Target Areas/ Name of exercise to be Deviation
Exercises Session# linked Forward head Chin tuck 1: Lying chin tuck
2: Lying chin tuck 3: Lying chin tuck Kyphosis Rowing (scapula) 1.
Prone on the floor arms bent beside your head 2. Prone on the floor
arms bent beside your head 3. standing bilateral rowing with
elastic resistance external shoulder 1. Side lying no weight
rotation 2. Seated with elastic resistance 3. Seated with elastic
resistance Trunk extension 1. Back extension with arm assistance 2.
Back extension with arm assistance 3. Back extension with pillow
under hips arms by your side (if capable) Pec stretch 1. Supine,
arms out to the side palms up 2. Supine, arms out to the side palms
up 3. Unilateral chest stretch hyperlordosis Abs abdominal
hollowing (isometric) all sessions Hip extensor 1. Isometric hip
squeeze strengthening 2. Bridge (very low) 3. Bridge (very low) Hip
flexor stretch 1. Lunge stretch holding a chair 2. Lunge stretch
holding a chair 3. Lunge stretch holding a chair Lower back stretch
Supine, knees to chest (all sessions) hypolordodis Back extension
1. Back extension with arm assistance 2. Back extension with arm
assistance 3. Back extension with pillow under hips arms by your
side (if capable) Hip flexor 1. Seated knee lifts no strengthening
weight (in a chair) 2. Seated knee lifts with weight (in a chair)
3. Standing leg lift front with weight (if tolerated otherwise no
weight) Hamstring stretch Supine, on the floor with a towel around
the foot (all sessions)
While the invention has been described in connection with specific
embodiments thereof, it will be understood that it is capable of
further modifications and this application is intended to cover any
variations, uses, or adaptations of the invention following, in
general, the principles of the invention and including such
departures from the present disclosure as come within known or
customary practice within the art to which the invention pertains
and as may be applied to the essential features hereinbefore set
forth, and as follows in the scope of the appended claims.
* * * * *